Pre-operative hip abductor muscle function in osteoarthritis, a comparison with healthy asymptomatic individuals

grantor: University of TorontoHip abductor muscle function was examined in 17 young healthy males (YN), nine older healthy individuals (ON) and 11 patients with hip osteoarthritis (HOA). Tensor Fascia Latae (TFL) and Gluteus Medius (Gmed) electromyography during isokinetic hip abduction and ambulation were recorded. The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index was used as a measure of clinical status. Isometric (ISO), concentric (CON) and eccentric (ECC) hip abductor muscle strength were decreased in HOA patients (p $<$ 0.005) when compared to ON individuals. Increased activity of TFL and decreased activity of Gmed were observed during the stance phase of gait in HOA patients. Gait velocities were decreased in HOA patients (p $<$ 0.03). Patients spent proportionately less time in single support and more time in double support during the stance phase of gait. Significant positive correlations between gait velocity and CON hip abductor strength (r = 0.56, p = 0.013) and between gait velocity and ECC hip abductor strength (r = 0.54, p = 0.016) were found. WOMAC signal measures 'pain' and 'difficulty' while walking significantly related to CON (r = $-$0.94, p = 0.0001, r = $-$0.66, p = 0.027) and ECC (r = $-$0.84, p = 0.0003, r = $-$0.60, p = 0.048) hip abductor strength. Although a relationship exists between pain and hip abductor muscle strength, and between gait velocity and hip abductor muscle strength, the relationship between pain and gait velocity requires further investigation.M.Sc

Trunk Function and Ischial Tissue Health in Spinal Cord Injury

Pressure injuries are a common secondary complication following spinal cord injury (SCI). Since individuals with SCI have sensorimotor impairments, they neither can feel pain associated with tissue damage due to prolonged unrelieved pressure nor are able to prevent pressure injuries due to mobility impairments. Deep tissue injury is a form of pressure injuries that occurs in the muscle and subcutaneous tissue before tissue breakdown appears at the skin surface. This thesis attempted to address four research questions pertinent to deep tissue injury and offloading in individuals with SCI. First, we proposed a quantitative ultrasound imaging approach to characterize the integrity of the tissues overlying the ischial tuberosity. We demonstrated that the thickness and gray scale measures of the skin, subcutaneous tissue and muscle has potential to be used as a tissue health monitoring approach. The second study investigated our ability to assess trunk strength and function using the multidirectional reach test. This study demonstrated that monitoring changes in trunk strength and reach distance could be used to assess trunk function in individuals with SCI. The third prospective cross-sectional study aimed at determining if there is a relationship between trunk function and offloading of the ischial tuberosities in individuals with SCI. We discovered that trunk strength was significantly higher in people who were able to Reach compared to Non-Reachers, and that offloading times over the ischial tuberosities were lower in Non-Reachers vs. Reachers. Regardless of an individual’s ability to engage in a reaching task, participants with SCI spent more time offloading the left ischial tuberosity compared to the right ischial tuberosity. The fourth exploratory prospective cross-sectional study compared thickness and texture measures of tissue overlying the ischial region in able-bodied vs. SCI participants. We discovered that the area occupied by muscle was significantly greater in the SCI participants when compared with the able-bodied cohort. Individuals who did not engage in offloading had more homogenous skin, subcutaneous tissue and muscle. These studies represent the first step towards better understanding the relationships between offloading, trunk function and health of tissue overlying the ischial tuberosity in SCI population.Ph.D.2019-07-10 00:00:0

Measuring Repositioning in Home Care for Pressure Injury Prevention and Management

Despite the widespread agreement on the need for the regular repositioning of at-risk individuals for pressure injury prevention and management, adherence to repositioning schedules remains poor in the clinical environment. The situation in the home environment is likely even worse. Our team has developed a non-contact system that can determine an individual’s position in bed (left-side lying, supine, or right-side lying) using data from a set of inexpensive load cells placed under the bed. This system was able to detect whether healthy participants were left-side lying, supine, or right-side lying with 94.2% accuracy in the lab environment. The objective of the present work was to deploy and test our system in the home environment for use with individuals who were sleeping in their own beds. Our system was able to detect the position of our nine participants with an F1 score of 0.982. Future work will include improving generalizability by training our classifier on more participants as well as using this system to evaluate adherence to two-hour repositioning schedules for pressure injury prevention or management. We plan to deploy this technology as part of a prompting system to alert a caregiver when a patient requires repositioning

Effects of Seated Postural Stability and Trunk and Upper Extremity Strength on Performance during Manual Wheelchair Propulsion Tests in Individuals with Spinal Cord Injury: An Exploratory Study

Objectives. To quantify the association between performance-based manual wheelchair propulsion tests (20 m propulsion test, slalom test, and 6 min propulsion test), trunk and upper extremity (U/E) strength, and seated reaching capability and to establish which ones of these variables best predict performance at these tests. Methods. 15 individuals with a spinal cord injury (SCI) performed the three wheelchair propulsion tests prior to discharge from inpatient SCI rehabilitation. Trunk and U/E strength and seated reaching capability with unilateral hand support were also measured. Bivariate correlation and multiple linear regression analyses allowed determining the best determinants and predictors, respectively. Results. The performance at the three tests was moderately or strongly correlated with anterior and lateral flexion trunk strength, anterior seated reaching distance, and the shoulder, elbow, and handgrip strength measures. Shoulder adductor strength-weakest side explained 53% of the variance on the 20-meter propulsion test-maximum velocity. Shoulder adductor strength-strongest side and forward seated reaching distance explained 71% of the variance on the slalom test. Handgrip strength explained 52% of the variance on the 6-minute propulsion test. Conclusion. Performance at the manual wheelchair propulsion tests is explained by a combination of factors that should be considered in rehabilitation.Peer Reviewe

Understanding disability in healthcare: exploring the perceptions of parents of young people with autism spectrum disorder

Purpose: How autism spectrum disorder (ASD) is understood (i.e., as a medical problem or natural human variation) has profound implications for how healthcare services are designed and delivered. As the recipients of these services, children and families are highly invested in these debates, yet little research has sought to investigate their views. The purpose of this study was to explore parents’ conceptualizations of ASD in relation to disability, and how they align with, or diverge from, conceptualizations they encounter within healthcare. Materials and methods: Nine semi-structured qualitative interviews were conducted with parents of children with ASD and thematically analyzed. Results: The accounts suggested that participants integrated multiple and sometimes contradictory conceptualizations of disability that reflected both “medical” and “social” models and sources of disablement. While the participants often advocated for acceptance and inclusion of their child, the label of “neurodiversity” was commonly rejected due to the concern for potential loss of funding for services. Conclusions: Study findings highlight the relationship between how parents conceptualize ASD and their experiences accessing supportive services within current delivery structures. Implications for ASD service providers emphasize accommodating parents’ unique and evolving values and priorities for healthcare and their relation to current service systems. Implications for Rehabilitation Parents conceptualizations of ASD both inform and are influenced by their experiences of accessing supportive services. This study highlights that parents’ perspectives are fluid, context-dependent, and do not exclusively represent a single model or perspective of disability. To meet family needs, service providers including healthcare professionals must recognize parents’ unique understandings of their child’s ASD and appreciate how healthcare shapes these perceptions